Provider Demographics
NPI:1831648369
Name:KUNNAPPILLY, TANYA (LMSW)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:KUNNAPPILLY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:KUNNAPPILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2009 E VISTA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4140
Mailing Address - Country:US
Mailing Address - Phone:602-279-5262
Mailing Address - Fax:602-263-0460
Practice Address - Street 1:4041 N CENTRAL AVE BLDG C
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-3313
Practice Address - Country:US
Practice Address - Phone:602-279-5262
Practice Address - Fax:602-263-0460
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ161911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical